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Even as the Economy Grew, More Children Lost Health Insurance

The share of children with health coverage in the United States fell for the third consecutive year in 2019, according to census data, after decades of increases.

The decline occurred during a period of economic growth — before the coronavirus pandemic caused broad job losses that might have cost many more Americans their health insurance.

A report Friday by the Georgetown Center for Children and Families found that the ranks of uninsured children grew the most in Texas and Florida, and that Latino children were disproportionately affected. Nationally, the number of children without health insurance rose by 320,000 last year alone, to a total of nearly 4.4 million children, the report found.

“What’s so troubling about this data is we were making so much progress as a country,” said Joan Alker, the center’s executive director and an author of the report. “And now that progress is clearly reversing.”

The picture since the start of the pandemic is less clear. Many families have lost jobs that came with health coverage, which could increase the number of children without insurance. But national enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) has also swelled, aided by temporary policies to prevent families from losing coverage during the emergency. More current estimates for the uninsured rates among children will take time.

In recent years, falling enrollment in Medicaid and CHIP drove the overall changes, according to the report. Although those programs for low- and middle-income children are primarily managed by state governments, Trump administration policies could be playing a role: The administration has encouraged states to check eligibility more often, which advocacy groups say has caused many families to lose coverage because of paperwork errors and missed deadlines.

And the administration’s policies on immigrant families have caused some to end enrollment for their children even though they are eligible citizens, according to child welfare groups in several states with the largest drops. In particular, the “public charge” rule makes it harder for immigrants to be approved for green cards if they have received public benefits or are deemed likely to receive them in the future.

“They were coming to me saying: ‘Please close my case. I don’t want to get into any trouble,’” said Graciela Camarena, outreach program director in the Rio Grande Valley for the Texas branch of the Children’s Defense Fund, a group that helps enroll children in health coverage. Ms. Camarena said most clients would not be affected by the public charge policy if they signed up their children, but news of the rule had produced widespread concern.

Trump returned to the Oval Office even as the White House outbreak grew.

President Trump returned to the Oval Office on Wednesday, even as a full picture of his health remained unclear and many of his aides were in quarantine amid a West Wing outbreak that continues to grow.

White House officials said he went in for an update on the stimulus talks that he had called off Tuesday. And two people close to the White House said that advisers were exploring the possibility of resuming travel events for the president next week.

Despite the president’s insistence on returning to seeming normalcy, experts on the virus say he is entering a pivotal phase in the disease — seven to 10 days after the onset of symptoms — when some patients take a turn for the worse.

Underscoring the potential dangers, a White House memo instructed staff members to follow new safety protocols, among them some that Mr. Trump has previously dismissed. They include surgical masks and protective eye covers. Many health experts believe the West Wing outbreak is a result of White House officials ignoring precautions recommended by public health experts.

Mr. Trump told the White House medical staff that he was feeling “great” and was symptom-free, according to a statement released Wednesday by his physician, Dr. Sean P. Conley. But Dr. Conley offered few further details about the president’s treatment, including whether he was still taking a steroid.

Dr. Conley’s statement said Mr. Trump has not needed supplemental oxygen since returning from the hospital. But the full picture of the his health remains murky. Doctors, for instance, have not shared results of the president’s chest X-rays or lung scans, crucial measures of the severity of his illness.

The president — trailing in the polls and less than a month away from the election — is trying to project the image of a healthy leader, and not of a patient with Covid-19. He has said he plans to be at the next debate, on Oct. 15, when he could still be contagious. His opponent, former Vice President Joseph R. Biden Jr., says there should not be a debate if the president still has the virus.

Since leaving the hospital Monday evening, the president has returned to minimizing the seriousness of the pandemic — even as many states in the country are experiencing serious outbreaks.

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